Fentanyl is often deadly; it's 50 percent to 100 percent more potent than heroin. DEA has put out a law enforcement warning to cops saying that if they even suspect something is fentanyl, don't touch with bare hands and wear masks.(Photo: File photo)

Fentanyl and related potent opioids were involved in more than half of the 4,050 drug overdose deaths in Ohio last year, according to a new report by the Ohio Department of Health.

Unintentional drug overdose deaths have more than doubled over the past five years due to the prevalence of the powerful opioids, which can be hundreds of times more potent than heroin.

Since 2011, Butler County's overdose death rate has ranked second in the state, and Clermont County's has ranked fourth, the Department of Health said Wednesday.

Earlier that day, Gov. John Kasich had touted the decline in prescription drug overdoses, which he attributed in part to limiting the number of pain pills doctors could prescribe. But heroin and now fentanyl deaths have dwarfed prescription pill-related deaths, overtaking the state's efforts to stanch the drug epidemic.

“This challenge keeps morphing,” Kasich said.

In 2016, coroners across the state also noted a marked increase in the presence of cocaine – nearly a 62 percent year-to-year increase – making it the third most-prevalent drug in unintentional drug overdose deaths. More than half of those with cocaine in their system also had fentanyl, according to the state report.

In Greater Cincinnati:

Warren County saw the largest percent increase in overdose deaths from 2015 to 2016. Last year, 58 people died of drug overdoses, up from 42 in 2015. The county's annual overdose death rate since 2011 trails the state average.

Overdose deaths in Butler County increased from 195 in 2015 to 211 in 2016. In the last five years, the county has seen 37.9 overdose deaths annually per 100,000 residents, the second-highest in the state.

In Clermont County, the overdose death rate was 37.5 per 100,000 residents, fourth-highest in the state. Ninety-six people died of an overdose last year, down from 105 in 2015.

In Hamilton County, 318 residents died of an unintentional drug overdose in 2016, down from 335 in 2015. Since 2011, the rate of local deaths was 29.4 per 100,000 residents, 13th highest in the state.

The state's annual overdose death rate per 100,000 residents was 22.2 over the last five years. Montgomery County has the highest rate of overdose death with 40 per 100,000 residents.

Among those who died of an unintentional drug overdose in 2016, the Ohio Board of Pharmacy reported over 80 percent had a history in Ohio of being prescribed prescription pain medication at some point.

The state has targeted prescribing guidelines and monitoring of opioids such as OxyContin and Vicodin in an effort to curb the number of deaths.

“We’re trying to regulate prescription drug prescribing so fewer people get addicted and fewer people transition" to stronger opiates, said Steve Schierholt, director of the Ohio Pharmacy Board.

Among those efforts is encouraging doctors to review the state’s prescription monitoring system; in June there were 327,000 queries per day to the system up from just 77,000 queries per day in June 2016, Schierholt said.

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The spike in fentanyl and carfentanil across the state often obscures the impact those efforts are having. While prescription pain medication was present in 667 unintentional drug overdose deaths in 2016, that was the lowest number since 2009 and the fifth straight year there has been a decline, according to the report.

In addition, 50,000 Ohioans are in recovery with the aid of medication assisted treatment like Vivitrol and Suboxone.

“We have a lot of people in recovery in this state,” said Dr. Mark Hurst, Ohio Department of Mental Health and Addiction Services’ medical director. “We don’t want to promote, 'If you use these drugs, everyone dies,' because a lot of people recover.”

Enquirer state capital reporters Jessie Balmert and Chrissie Thompson contributed to this report.